Provider Demographics
NPI:1386012169
Name:HEALTHY LIVING FAMILY CARE CENTER BATON ROUGE
Entity Type:Organization
Organization Name:HEALTHY LIVING FAMILY CARE CENTER BATON ROUGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARDY
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-687-7832
Mailing Address - Street 1:4962 FLORIDA BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4031
Mailing Address - Country:US
Mailing Address - Phone:225-663-2445
Mailing Address - Fax:
Practice Address - Street 1:4962 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4031
Practice Address - Country:US
Practice Address - Phone:225-663-2445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD205405261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2195859Medicaid
LA2410733Medicaid
LA2368176Medicaid
LA2410733Medicaid